WHEN I was younger, my grandfather taught me how to play squash. We played at courts that were on the grounds of the Royal Children’s Hospital at Parkville in Melbourne. My grandfather was a paediatrician and he’d been using the courts since the hospital was first built back in the 1960s.

We probably played a half dozen times and I don’t ever remember seeing the courts used by anyone else. To use them you had to sign a key out from the hospital reception and there were long gaps between each entry in the ledger.

The courts themselves were in a state of disrepair. This was back in the 1990s, when the sport of squash had fallen a little out of favour and so it was fitting that the courts would be semi-ruined and forgotten.

That hospital building is gone, replaced by a far more pleasant and much better designed building adjacent to the original site. The new building has been designed for its patients and the wards are bright and cheerful and named after Australian fauna. There are aquariums in the lobby and an enclosure filled with meerkats on loan from Melbourne Zoo.

The squash courts weren’t incorporated into the rebuild, which is unsurprising given the seeming lack of appetite for these types of facilities. And the modern workplace is a different beast. We are now all consumers who transact business in our workplace so that can we spend our vanishingly scarce leisure time elsewhere and on our own terms.

Where I currently work, there was once a swimming pool and tennis courts on the hospital grounds, but that land has since been used to build offices for the growing numbers of administrative staff.

My former workplace had a small staff gym that was a huge hit with doctors, nurses, orderlies and admin staff. The health district is now offering discounted memberships to external gyms, so its own gym will likely wither and die. It’s obvious these sorts of facilities are considered non-core business by hospital administrators and it’s therefore more sensible to outsource them to third-party providers.

When my grandfather was a resident, at a time when the term retained its original meaning, the hospital was a thriving little community where the staff had access to all sorts of facilities. He and his colleagues worked long hours, far longer than most of us are used to working today.

Yet I don’t believe that their rates of burnout and mental illness were higher than ours. My grandfather remembers those years as some of the happiest of his working life.

Hours alone can’t explain the malaise that seems to strike so many doctors, and in particular junior ones.

My grandfather felt a sense of belonging to the hospital community that few of us would feel

today. We miss those opportunities to experience associations between work and feelings of joy, pleasure, happiness or belonging. Humans are emotional creatures and without these associations it’s easy to become cynical and detached.

Employers in some other industries seem to have a better grasp on this. I have friends who work in technology and the often satirised Silicon Valley stereotypes have at least some basis in reality. My friends play table tennis at work, lounge on beanbags and drink craft beer from the office fridge. They’re even encouraged to spend time on personal projects and attend conferences.

The bean bags and table tennis seem a little try-hard. But in other ways these canny employers are demonstrating that they understand the value of small gestures in transforming the workplace from a place of transaction to a place of belonging. That leads in turn to happier and more productive workers. They could abolish these perks and pass on the cost savings to their employees in hard cash, but they know they’d get less bang for their buck.

There have been a lot of improvements in hospital design. In many ways they’re much brighter and more comfortable spaces for patients. But patients’ experiences still depend on the happiness and wellbeing of the staff who look after them.

We focus much of our efforts on trying to address the downstream effects of an unhealthy workplace. Offering counselling to burnt-out doctors is hugely important but it recalls the adage about horses and stable doors.

Perhaps more could be achieved, and we’d feel less wrung-out and oppressed, if we could incorporate moments of joy into our working life. We could start by reviving the squash courts, or at least a modern-day equivalent: any space that brings hospital employees together, in a relaxed and fun way, in a momentary escape from the stresses and strains of work.

Dr James Dando is a junior doctor at a major hospital.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

17 thoughts on “Burnout: hospitals need to be doctor-friendly as well”

I couldn’t agree more. It’s not the hours, but the battles with nurses who no longer respect our training (no matter how hard we try to listen to them and be helpful) and relentless systems and administrators, and the total lack of job security that is causing us to become so disenfranchised. A staff swimming pool would actually make an enormous difference to my life!

I agree that, while the hours worked by junior doctors has reduced from my training in the late70’s the practice of hospital medicine is much more intense-faster turnover of patients, more investigations, referrals and paperwork required and , since no one lives in any more there is no sense of belonging to a hospital community and the chances of being able to moan, debrief, laugh and gerneally hang out with peers (which is 100 per cent better thancounselling -whenever they are supposed to find time for that) is minimal. Why do we fail to recognise that doctors (and other workers) have human needs and function better as well as more happily if these are considered?

My father worked as a radiologist in a country town. I did my medical elective in the same hospital. You could order your lunch in the morning ( simple sandwiches and fruit and muffins. It was offered for free), pick it up in a brown paper bag from 12 noon and eat it in the modest staff room that was filled with cool mid-century furniture, old medical books and photographs of people who had worked there over the years. Its the best experience I’ve had in terms of workplace conditions in a hospital. Just such a simple thing as a free simple lunch that would have cost the hospital very little, a comfy staff room that offered a quiet 1/2 hour break and a chance to catch up with other staff who I would not otherwise see. Sometimes interesting information like research projects in other specialities are discussed informally. Now, if I get lunch at all I have to line up with patients and their families in the privately owned cafeteria. Sometimes its difficult to negotiate privacy with certain patients and their families whilst waiting for my overpriced sandwich and coffee. Its not just that. I have often let patients families order before me because I empathise with their needs and want to show them I care about their time. This adds time to my getting lunch. Time I don’t have, unless, of course, I work overtime. Which I do regularly. As a junior doctor, I would absolutely prioitise a hospital that offered a free simple lunch in a staff room and reasonably priced parking. I don’t require a gym. I don’t require fancy yoga classes that I would never have time to attend. I would like a half hour break and food.

My best work-life experience in a hospital was at a rural hospital where you could order some sandwiches in the morning (it was packaged at an astonishingly low price) and pick it up in a brown bag at noon with some free fresh fruit and go and eat it in the doctors staff room which was simply furnished, had a small library of medical books and was quiet. I don’t need fancy facilities or yoga classes. I don’t need meetings to be catered with fancy finger foods. I just want some sandwiches and a quiet 1/2 hour to eat it and gather my thoughts. If a metropolitan hospital offered this to junior staff they would be inundated with applications…but… you know..management

When I qualified in 1973, most UK hospitals had a residents’ mess +/- a bar. It was the same here when I joined the trainees at a large Sydney hospital in 1980. Those who were going off duty could have a few beers, and those who still had hours to go might have one to quench a thirst. I don’t recall anyone working when they’d had too much to drink. The mess was a great place to meet especially when shifts changed. You met colleagues you’d been trying to talk to for days and patient care was improved not denigrated by the presence of the mess.

Sadly these days are long gone, as has the mess. Is there anyplace for juniors to meet socially and professionally? The wowsers have declared that you can’t work if you’ve even seen a beer in the previous 24 hours. As your correspondent relates, junior staff worked very long hours (I recall 72 hours shifts in theatre and living in on call) but the hospitals ran at least as well as they do nowadays.

Am I seeing this all through the rose coloured spectacles of pre-senile dementia? I don’t think so.

Classic Article!
Having suffered burnout myself I couldn’t agree more.
Back in my day (I’m sounding old but I’m still this side of 50yo) there were squash courts at RMH, WHF, RWH JUST TO NAME A FEW i.e. Royal Melbourne, Western Hospital Footscray, Royal Women’s Hospital.
They are now all gone and not replaced by any indoor/outdoor amenable facilities. The tennis courts at the Repat were GOLD. Need I say more…

I think the day the hospital administrators declared they were getting rid of the free tea and coffee for staff was the final nail in the coffin for staff morale. I often think that a simple gesture such as a free coffee or sandwich would remind staff that they are valued, and should improve productivity. Bringing back doctors rooms (?with free cheese toasties) on all sites is something we should fight for.

The swimming pool at RMH was donated by an Honorary (unpaid) surgeon in the 1960s for the use of the resident medical staff. In those days you lived in the RMO quarters when on duty and we all worked very long hours, sleeping when we could. Every now and then if your night on duty was Thursday you had what was known as the “long weekend” where you were on duty in the hospital from Thursday morning to Monday evening. Of course if nothing was happening in this time you could sleep, have a swim, play billiards, eat some toast or sit in the lounge and talk about the great case in bed 30 in 7 North. All of this within 20 metres of the main hospital building. You got to know everyone in the RMO staff and learnt so much about medicine from the more senior RMOs. I knew of no-one who became “burnt out” or at least admitting to it. These were probably the most stimulating and enjoyable years of my career. Bureaucratisation of medicine has finished all this.

There’s a webinar available to view on the eMHPrac page of the Black Dog Institute’s website that discusses the research-based characteristics that make workplaces mentally healthy. You can view it via http://www.blackdoginstitute.org.au/emhprac or directly via this link https://medcast.com.au/courses/263. It’s interesting to note just how far from the ideal hospitals are, not just in our experiential opinions but also in terms of the research.

HI James
Thank you for such a great article. I’m a paediatrician at RCH (rheumatologist) and have been doing some work in this area. Your article hits the spot with exactly what the doctors at RCH and at hospitals around Australia (and internationally) are saying.

I think the themes of loss of community, the need for a place and space for doctors to meet and debrief, to regularly break bread together, simple simple simple things and little kindnesses to build and hold our culture in the face of hard and difficult work and the very real need to listen to our doctors to help them create a real sense of engagement and place of belonging is critical. We are going to be changing this at RCH moving forward and there’s a group of us – with the Execs support – working out how best to do that. I love your article and when I was talking with many of the senior medical staff and alumni -so many mentioned the squash courts!
We are also just starting a network across Victorian hospitals to learn from each other about what we are all doing in this space and accelerate improvements (!!) and are meeting up in July so if you (or anyone else) wants to get involved feel free to email me jane.munro@rch.org.au.

Squash courts, tennis courts and pools sound very luxurious – I just want access to a computer that I can reliably access throughout the day rather than searching across several wards, an accessible cupboard or locker to put my bag in, and somewhere to eat the lunch I bring from home. A resident room or on call quarters for nights would be a bonus!! Somewhere to casually debrief and relax with other doctors would be a pleasure, but you know, the heirachy of needs…

I am a former medical student at RCH and am now a senior staff member at the hospital. I used to use that squash court and very much wish still had one there. Times have changed a lot and we and other hospitals- would benefit from more junior and senior medical staff collegiality. It makes a massive difference to people working long hours under great stress.

When the Queen Vic was closed and Monash Clayton opened in 1987 the original Clayton plans did not contain RMO facilities (night duty bedrooms or a Mess) at all. Management saw no reason why doctors should be so ‘privileged’ compared with all the other hospital ‘workers’. The QVMC RMO committee pointed out very strongly that no other group of workers were rostered ‘on’ for 50 to 70 hours straight with a need to shower, eat and occasionally sleep, and b) discussing cases and interacting with colleagues in a cafeteria environment alongside other staff and patients would be a breach of privacy and confidentially. A great deal of clinical business used to get done over lunch.
The collegiality of a tearoom (or wonder of wonders- a dining room) offers support in an environment of hard work and high demands on medical staff.